We have been warned. A catastrophic winter is coming for our acute hospitals. Already, more than 10,500 people have found themselves lying on hospital trolleys in September. Health Minister Stephen Donnelly and the HSE spoke about the difficult winter facing our health service.
and within our healthcare system, vital services operating within the community that fulfill an essential role in easing pressures on our hospitals and meeting the community care needs of our aging population are being forced to close.
Over the past few weeks, over 600 nursing home beds have been removed from our healthcare system due to the closure of 12 nursing homes. They say the funding environment in which they operate is unsustainable. It is demonstrative of a wave of closures occurring within the sector.
Over the past four years, over 40 nursing homes, providing care for over 1,500 of our most dependent citizens, have closed. Unfortunately, due to daily engagement with care homes, more closures are imminent.
Home nursing is absolutely integral to achieving an efficient, effective and well-functioning health care system.
Around 30,000 people benefit from nursing home care. Every year, an equivalent number of discharges are made from our acute care hospitals to nursing homes, fulfilling an absolutely vital role in easing the ongoing burden of hospital overcrowding and providing more appropriate community care. Those discharged from hospitals to nursing homes are seniors transferred from acute care hospital to community settings back home.
Nursing homes specialize in providing respite, rehabilitation, short-stay and long-stay care. For residents, nurses are available 24/7; caregivers are on site to meet the needs of daily life; the catering teams respond to nutritional and dietary wishes; the activities are designed to bring pleasure, happiness and support their physical and cognitive needs.
As people live longer, the greatest increase in our population is expected among the elderly. In addition to being celebrated, it must be planned. The Alzheimer Society of Ireland predicts that the number of people with dementia will double over the next 25 years. To improve patient flow in hospitals, the Ministry of Health projects that 12,000 additional residential care beds will be needed to meet the long-term and short-term health care needs of our population by 2031.
Yet hundreds of nursing home beds have been closed across our health care system, with providers citing care delivery as unsustainable under the current resident care funding framework. In August, regulator HIQA stepped in, citing concerns about the loss of a model of care within our health and social care services. A crisis in elderly care is unfolding.
The desperation within the sector stems not only from the loss of these essential people-centred health and social care providers, but also from the state’s turning its back on repeated and successive warnings that the operating pricing mechanism under the Fair Deal program is not fit for purpose.
A series of independent reviews by Nursing Homes Ireland have criticized the scheme and its enforcement by the National Treatment Purchase Fund (NTPF), acting on behalf of the state.
In an opinion piece we wrote for the Sunday Independent in 2017 we wrote about a report undertaken for the Department of Health in 2015 which described as untenable that HIQA, as the state regulator, could impose costs on nursing homes and that the price regulator, the NTPF, did not reflect them in its fee framework.
That same article reported that the Dementia Services Information and Development Center was advocating for more realistic allocation of resources by the state in recognition of the high dependency needs of nursing home residents. The closures are a direct result of successive governments’ failure to address the anomaly in resident care funding, with public HSE care homes receiving charges which average an additional €600 per resident, per week, above those payable to private individuals and volunteers. counterparts. It was a key finding of the Department of Health commissioned value-for-money review of care home nursing costs, finally released last December.
In a 2010 report evaluating the program shortly after its launch, then-ombudsman Emily O’Reilly questioned why the NTPF had been given sole authority to determine what costs would be made up in the Fair Deal fee. .
Two years ago, the Office of the Comptroller and Auditor General’s review of Fair Deal presented a damning conclusion that the NTPF could not provide it with a model to inform how it applies fees for resident care. nursing homes. The objective of this scheme is to finance specialized care for people with the highest health and social protection needs. Yet ESRI, the Public Accounts Committee, the Covid-19 Care Homes Expert Group, the Oireachtas Health Committee and the Ministers of Health and Aging have also said the charges of the fair agreement are not proportionate to the care needs of the residents. Twelve years after it came into force and a host of reports later commissioned by the Department of Health which pointed out that it was not fit for purpose, the pricing mechanism remains the same.
The multiple closures are due to a system without a proper support structure that is currently breaking. Behind the 1,500 lost beds are residents losing their homes, families fearing they will have to support their move, staff losing their jobs, communities losing an established care provider.
The obligation to heed the warning surrounding the inadequacy of the Fair Deal to support the care of nursing home residents came too late for many. Multiple shutdowns must now urgently compel the state to put in place an evidence-based, fit-for-purpose pricing mechanism. The ongoing crisis and intolerable pressure placed on our healthcare services will not be alleviated without an appropriate support program for the care of nursing home residents.
Tadhg Daly is CEO of Nursing Homes Ireland